Ann Surg Treat Res.  2017 Dec;93(6):300-304. 10.4174/astr.2017.93.6.300.

Quantitative assessment of liver fibrosis using shore durometer

• Yoon YC
• Lee JS
• Park SU
• Kwon JH
• Hong TH
• Kim DG

• KMID: 2396870
• DOI: http://doi.org/10.4174/astr.2017.93.6.300

Abstract

PURPOSE
The purpose of the present study was to investigate whether hardness of liver surface correlated with degree of liver fibrosis, and its association with posthepatectomy liver failure (PHLF).
METHODS
A shore durometer was used to measure hepatic hardness in 41 patients with hepatocellular carcinoma (HCC) and in 10 patients with normal liver. We investigated how hepatic hardness correlates with various values indicating the degree of liver fibrosis, and how it correlates with PHLF.
RESULTS
In the normal liver group, the surface shore units (SU) was 15.06 ± 2.64. In the HCC group, there was a correlation between surface SU and preoperative results indicating liver fibrosis. Among patients with PHLF after resecting over 3 segments, the surface SU of patients with grade A PHLF was 21.85 ± 5.63, and the surface SU of patients with grade C PHLF was 35.75 ± 9.26. In patients with PHLF after resecting 2 or less segments, the surface SU of patients with PHLF grade A was 20.95 ± 5.18, and the surface SU of patients with PHLF grade B was 31.60 ± 5.57. In predicting PHLF, surface SU was more effective than preoperative platelet count, spleen volume, or liver fibrosis index.
CONCLUSION
Hepatic hardness measured by the shore durometer was correlated with the degree of liver fibrosis. Liver surface SU was a more effective parameter for predicting PHLF, as compared to other indicators evaluated before hepatectomy. The decision to perform major hepatectomy should be reconsidered in cases with a liver surface SU of >30.

Keyword

Hepatic fibrosis; Liver failure; Hardness tests; Liver function tests; Hepatectomy

MeSH Terms

Carcinoma, Hepatocellular
Hardness
Hardness Tests
Hepatectomy
Humans
Liver Cirrhosis*
Liver Failure
Liver Function Tests
Liver*
Platelet Count
Spleen

Figure

• 

  Fig. 1 Technique of intraoperative durometer measurement of hepatic hardness.

Reference

1. Belyaev O, Herden H, Meier JJ, Muller CA, Seelig MH, Herzog T, et al. Assessment of pancreatic hardness-surgeon versus durometer. J Surg Res. 2010; 158:53–60.

2. Belyaev O, Polle C, Herzog T, Munding J, Chromik AM, Meurer K, et al. Effects of intra-arterial octreotide on pancreatic texture: a randomized controlled trial. Scand J Surg. 2013; 102:164–170.

3. Belyaev O, Rosenkranz S, Munding J, Herzog T, Chromik AM, Tannapfel A, et al. Quant itat ive assessment and determinants of suture-holding capacity of human pancreas. J Surg Res. 2013; 184:807–812.

4. Foitzik T, Gock M, Schramm C, Prall F, Klar E. Octreotide hardens the pancreas. Langenbecks Arch Surg. 2006; 391:108–112.

5. Tatsumi C, Kudo M, Ueshima K, Kitai S, Ishikawa E, Yada N, et al. Non-invasive evaluation of hepatic fibrosis for type C chronic hepatitis. Intervirology. 2010; 53:76–81.

6. Kim YW, Kwon JH, Jang JW, Kim MJ, Oh BS, Chung KW, et al. Diagnostic usefulness of real-time elastography for liver fibrosis in chronic viral hepatitis B and C. Gastroenterol Res Pract. 2014; 2014:210407.

7. van der Vorst JR, van Dam RM, van St iphout RS, van den Broek MA, Hollander IH, Kessels AG, et al. Virtual liver resection and volumetric analysis of the future liver remnant using open source image processing software. World J Surg. 2010; 34:2426–2433.

8. Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, et al. Surgery for small liver cancers. Semin Surg Oncol. 1993; 9:298–304.

9. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011; 149:713–724.

10. Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003; 29:1705–1713.

11. Feng YH, Hu XD, Zhai L, Liu JB, Qiu LY, Zu Y, et al. Shear wave elastography results correlate with liver fibrosis histology and liver function reserve. World J Gastroenterol. 2016; 22:4338–4344.

12. Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut. 2006; 55:403–408.